Athletic development specialists dedicated to the art and science of excellence in movement

Movement Reeducation for a 2:29 Marathoner: Case Study, Part 2

In part one of this case study we provided our initial screening and assessment before addressing this runner's nonpainful dysfunctional movement patterns. In this second of three parts, we'll cover the initial corrective exercises that we used to provide the foundation for running specific corrections.

Initial plan of attack: Corrective exercises
In the FMS methodology, our first goal is to identify the weakest link of movement, as the most fundamental weak link is frequently the culprit behind other dysfunctions. For this runner, the weakest links were the bilateral "1s" on the active straight leg raise and hurdle step screens. We immediately stressed the importance of self massage techniques with the foam roller and tennis balls. Although he had visited manual therapists, we made clear that using the at-home tools immediately pre and post run would thwart injuries by providing mobility in areas that stretching alone would not improve. Below are some of the key areas we addressed. At first these corrective exercises comprised the main set of the workout, but we progressed to where they served as warmups for more dynamic movements.

Active straight leg raise - Our first technique to address the active straight leg raise (and toe touch patterns) was the three step toe-touch progression.

This correction is fairly standard in the FMS corrective methodology and yields instant results. The first time he performed this progression he added approximately five inches of reach and nearly touched his toes for the first time in years. Whereas he had virtually no hip hinge and posterior weight shift in his original toe touch screen, the progression gave him the first signs of proper hip mechanics.

We also used supported leg lowering to train the active straight leg raise. To those unfamiliar with FMS corrective techniques, I describe leg lowering as "We'll give you the finish position and then work back to the start." With both legs in the air, we support one leg in a "perfect" finish position and let the other hip extend by lowering the non supported leg. For him, and for most people with 1s in the active straight leg raise, a big key is not simply the movement, but learning to control the movement with controlled diaphragmatic breathing.

Hurdle step - Initially we took an indirect approach to the hurdle step. Since hip extension is a critical part of the hurdle step pattern, the active straight leg raise correction worked double duty to address both patterns. We also worked to get him comfortable with hip flexion and extension in lunge stance and later progressed to chopping and lifting. Lunge stance also offered the chance to address big-toe mobility (more on that below). We used the Thomas Test stretch as part of each warmup and encouraged him to repeat that stretch at home daily.

Big toe mobility - We knew from the outset that his big toe mobility was limited by structure. In giving his body the awareness that more mobility is available, his running stride would evolve to utilize this added mobility and thereby relieve the strain on structures in the hips that had previously been forced to work above and beyond their intended roles. We didn't seek to actively change his foostrike, but knew that his gait would evolve on its own when his body realized it had more mobility to utilize in the big toe, which is a more efficient outlet for forward propulsion than the hip adductors and adductors.

In terms of corrective techniques, we had him use a tennis ball for self massage on the balls of his feet. We borrowed mobility techniques from Keats and Franz Snideman.  The "sumo squat plie" (reflected in Keats' and Franz' video) was interesting to because our runner had a difficult time balancing the first time he tried it.  No wonder he didn't use that big toe while running!  With each passing week his mobility in the toe increased and his balance improved.

Pelvic tilt - The pelvic tilt is not formally part of the FMS but is included in the Titleist Performance Institute screen, which we sometimes use for non-golfers. Our rationale behind emphasizing a corrective strategy for his inability to pelvic tilt was that uneven surfaces, even on soft dirt, provoked more discomfort than running on flat ground. Without the malleability to adjust his pelvis in response to changes in the terrain, he placed his hips under more pressure than they were capable of absorbing.

Our first stage of correction was to give him a "jump start" on all-fours. We then taught him to do the tilts in tall-kneeling stance, which allowed him to do the "jump start" by himself. By week four he was able to pelvic tilt with satisfactory range while standing. 

Ankle mobility - Our rationale behind addressing ankle mobility was the same as addressing big toe mobility: make greater mobility available and let the stride evolve to use this mobility and take pressure off areas that had been forced to bear more load than they were intended to absorb. Ultimately, we knew that his ankle restrictions were in part a localized expression of an inactive posterior chain (which included a forward head, flexed T-spine, hypertonic or perpetually firing hip flexors, flexed knees at rest, and inactive glutes). 

Preview - We used the foundation from these corrective exercise strategies to safely address the dynamic running skills needed to keep him healthy while undertaking the high training loads needed to achieve his goals.  In the forthcoming final installment of this case study, we'll discuss our strategy for incorporating running drills into his training.  We use drills not to coach "form" per se, but instead to cultivate advanced movement skills.  Drills are most productive when fortified by the sound base of fundamental movement that we cultivated through the above listed corrective strategies.  


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